Dueling Medicaid data

April 9, 2013|By Maria Mallory White, Staff writer

Broward County still stands to lose millions of dollars in Medicaid reimbursements, but exactly how much is still being debated.

In response to figures showing Florida's public hospitals would take a huge financial hit under the Senate's Medicaid proposal, Senate lawmakers on Monday received more details about the impact of the plan.

The Senate's budget proposal for Medicaid reimbursements confirm millions of dollars in lower payments ahead for Broward County's two major public hospitals, according to a letter released Monday by Sen. President Don Gaetz.

Although the newly released Senate figures do not reflect systemwide totals, according to the Senate calculations, Broward Health Medical Center would lose $4.6 million in Medicaid reimbursements. Memorial Regional Hospital would lose $2.8 million. These figures are, in fact, larger than the calculations release last week by the Safety Net Hospital Alliance of Florida (SNHAF), which criticized the Senate plan.

In response to such criticism, Gaetz asked Senate Appropriations Chair Denise Grimsley, R-Sebring, to explain to her Senate colleagues the difference between the Senate and House proposals, which reflected significantly smaller decreases for Broward's public hospitals.

Both chambers have crafted plans to move from a traditional fee-for-service approaching to paying back hospitals that care for the state's poor and uninsured patients covered by Medicaid. Instead of reimbursing the average costs to generally treat Medicaid patients, lawmakers are adopting the approach used in the Medicare program known as a diagnostic-related group system (DRG). It pays based on the type of disease the patient is being treated for.

The Senate plan does not fully account for cost-related factors faced by Broward hospitals, such as the higher wages paid to its urban workers, said Tony Carvalho, president of the Safety Net Hospital Alliance of Florida.

"We think that when appropriate adjusters are made to the Senate model, the losses that these safety net hospitals will incur in the Senate model will be significantly less," he said in a phone interview Monday.

"We started with the philosophy of selecting a limited number of targeted adjusters," Grimsley said in an e-mail Monday. "We emphasized Graduate Medical Education and prioritized adjusters for pediatrics and rural areas. Our primary concern was keeping the base rate high. Adding more adjusters beyond those we prioritized depletes the base rate."

Such rates could play a role in upcoming negotiations with health insurance companies who hope to win contracts to provide Medicaid managed care plans when the state switches to such coverage in 2014.

"The only rationale for doing it now would be if in fact the contracts with the managed care companies that the state signs also call for them to pay the hospitals on a drg basis," said Linda S. Quick, president of South Florida Hospital and Healthcare Association.

"We believe there is a need for a state-established rate," said Katie Betta, spokeswoman for Gaetz. "We believe that rate could be used, would be looked to [as a benchmark] in contract negotiations going forward."